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The Pathologic Peritoneal Cancer Index (PCI) Strongly Differs From the Surgical PCI in Peritoneal Metastases Arising From Various Primary Tumors

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The surgical peritoneal cancer index (sPCI) is calculated based on a subjective evaluation of the extent of peritoneal disease during surgery. The pathologic PCI (pPCI) may be a more accurate and objective method for determining the PCI. This study aimed to compare the sPCI and pPCI and to study the potential pitfalls and clinical implications of using the pPCI.

Methods

This prospective study (July to December 2018) included all patients undergoing cytoreductive surgery (CRS). The pPCI was calculated for each patient and compared with the sPCI. The impact of potential confounding factors on the difference between pPCI and sPCI was evaluated.

Results

Among 191 patients undergoing CRS at four centers, the pPCI and sPCI were concordant for 37 patients (19.3%). The pPCI was lower than the sPCI for 125 patients (65.4%) and higher for 29 patients (15.1%). The concordance between the two groups was maximum for gastric cancer (38.8%) and colorectal cancer (27.6%) and least for mesothelioma (6.7%) and rare primary tumors (5.6%) (p = 0.04). The difference was 0 to 3 points for 119 patients (62.3%), 4 to 5 points for 27 patients (14.1%), and more than 5 points for 45 patients (23.5%). The rate of concordance was not influenced by the use of neoadjuvant chemotherapy (NACT) (p = 0.4), but the difference was greater when NACT was used (p = 0.03).

Conclusions

The pPCI strongly differs from the sPCI for patients undergoing CRS for peritoneal disease and may provide a more accurate evaluation of the peritoneal disease extent. Further studies are needed to determine its prognostic value compared with sPCI, and consensus guidelines are needed for calculating it.

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Authors and Affiliations

  1. Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India

    Aditi Bhatt MS, MCh, Sakina Shaikh BHMS & Mahesh D. Patel MS, MCh

  2. Peritoneal Metastases Center, Kishiwada Tokushukai Hospital, Osaka, Japan

    Yutaka Yonemura MD, PhD

  3. Department of Surgical Oncology, Saifee Hospital, Mumbai, India

    Sanket Mehta DNB & Praveen Kammar MS, MCh

  4. Department of Pathology, Centre Hospitalier Lyon-sud, Lyon, France

    Nazim Benzerdjeb MD, PhD & Sylvie Isaac MD, PhD

  5. Department of Pathology, Zydus Hospital, Ahmedabad, India

    Loma Parikh MD

  6. Department of Surgical Oncology, Thangam Cancer Centre, Nammakkal, India

    Aruna Prabhu MS, MCh

  7. Department of Pathology, Fortis Hospital, Bangalore, India

    Suniti Mishra MD

  8. Department of Pathology, Saifee Hospital, Mumbai, India

    Mita Shah MD

  9. Department of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France

    Vahan Kepenekian MD, Isabelle Bonnefoy MD & Olivier Glehen MD, PhD

  10. Hospices Civils de Lyon, Centre Hospitalier Lyon-sud, Lyon, Pierre Bénite, France

    Olivier Glehen MD, PhD

Authors
  1. Aditi Bhatt MS, MCh
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  2. Yutaka Yonemura MD, PhD
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  8. Suniti Mishra MD
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  9. Mita Shah MD
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Corresponding author

Correspondence to Olivier Glehen MD, PhD.

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Conflict of interest

Olivier Glehen has received honoraria from Gamida Tech. Nazim Benzerdjeb has received honoraria from MSD, Pfizer, and AMARAPE (association created by patients with two rare diseases of the peritoneum: PMP and mesothelioma). The remaining authors have no conflicts of interests

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Bhatt, A., Yonemura, Y., Mehta, S. et al. The Pathologic Peritoneal Cancer Index (PCI) Strongly Differs From the Surgical PCI in Peritoneal Metastases Arising From Various Primary Tumors. Ann Surg Oncol 27, 2985–2996 (2020). https://doi.org/10.1245/s10434-020-08234-x

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  • DOI: https://doi.org/10.1245/s10434-020-08234-x

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